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Being a Public Psychiatric Patient

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As I said in my last post, I have stayed in two different types of hospital situation when I have been hospitalised for mental health issues. In the local public hospital and in a private psychiatric hospital. I have never had the dubious pleasure of being admitted to a public psych ward. 

My stays in the public hospital were in the general ward and the ICU. Obviously when I was in the ICU I wasn’t at all well as the result of an overdose. As soon as I was a bit more with it, I was moved to the general ward. I have been in the Emergency Department of two public hospitals with mental health issues and in the general ward of two public hospitals for the same reason. One was a quite large regional hospital, one was a large regional hospital and the other was a very small hospital in a country town (so small it didn’t even have its own Emergency Dept).

The response of staff in the ED to patients with mental health issues has improved over time. The first time I was at the ED was in 1990, the last time was in 2011. In 21 years things had changed for the better. They still aren’t perfect of course but generally much much better. The same goes for the general ward. I found the nurses much more empathetic in recent years than they were back in the 90s and early 2000s. I found the residents (doctors) much more able and willing to deal with a patient with mental health issues. In 1990 when I overdosed as a 16 year old, psych services wasn’t even called. Now I can rock up to the ED and ask them to call psych services and they will. And psych services will come. Eventually. The times I went to the ED in 2011 (several times) I had the most incredible psych services worker come to see me. He was great. Everything you could want in a psych nurse/worker. Brilliant in fact. I will never forget him and how much he helped me when I needed it. 

Being an inpatient on a general ward means you see more people. There are staff in and out all day long and there are usually visitors, if not for me then for the other people in the ward (generally a two patient ward). There isn’t a lot of privacy and there isn’t much chance of sleep. Basically a psych patient is kept in a general ward if they are a suicide risk (but not at risk of harming anyone else other than themselves) or if they are changing medications/withdrawing from medication/starting a new medication. And, in my experience, a psych patient is only put on the general ward if they are a client of Community Mental Health Services and there is no designated psych ward at their local hospital. A patient with a private psychiatrist is not likely to be admitted to a public hospital unless maybe they are recovering from an overdose or the like.

As I live in the country, there have never been many (if any) private practicing psychiatrists in this area. If you wanted private you had to travel at least 2 hours. If you needed a shrink you had to take your chances with Community Mental Health/Psych Services. When I was a client of theirs I saw a different shrink nearly every appointment I had. And I can’t say I would sing the praises of any of those shrinks. CMHS went through psychiatrists like normal people go through underwear. And you had to be in crisis to remain on the books. A Community Mental Health patient would get a case worker for 6 weeks. If you were stable (even remotely) at the end of 6 weeks, your case was closed. If things went to shit again after that, you had to be assigned a new case worker and start all over again. It was hell. 

Unfortunately last year when I was having a rough time, I didn’t have an after hours contact for my private psychiatrist so when things got bad, I had to be taken to the local hospital’s ED and they would called CMHS. As I said earlier, I was lucky that I got an amazing worker who knew exactly what he was doing and how to help me. Other patients aren’t so lucky. CMHS workers in my area are on call after hours and it is generally a wait of at least an hour usually more before they arrive (they are usually based in a town about 45 minutes away). So a patient with mental health issues has to either sit in the public waiting room with everyone else or if they are lucky, be put in a cubicle in the ED and tell their story to every nurse and resident that wanders in (and they do so on a regular basis). Not to say any of them treated me badly, they just all wanted to know what was wrong, how I was feeling etc etc. I didn’t want to talk to anyone. Thankfully my partner did some of the talking for me when I just could not (or would not) talk myself. 

Living in the country there is always the issue of already knowing the nurses or other staff members at the hospital. This has happened to me a few times. Once I asked to see someone else for my triage assessment. Another time it didn’t bother me that it was someone I knew. Back in the 90s and early 2000s the ward nurses would often just stay away from me as a psych patient. I felt a distinct disapproval from some of them. Not so much in later years. Maybe the stigma of mental illness is changing slowly over time. Maybe. 



The Original Diagnosis and the Dead Shrink

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So I took myself to a town some way down the highway to see a private psychiatrist. There were no such services in my town and my GP at the time didn’t even mention Community Mental Health Services (I now know why!). 

The psychiatrist was an older man. Slight in stature and build, greying. Reasonable bedside manner. After hearing my story he diagnosed Bipolar Disorder and gave me my inaugural seat on the medication merry-go-round by prescribing lithium. 

A week or so later I saw a death notice in the local paper for a man by the same name as the Shrink. It wasn’t a particularly common name so I rang the clinic to see if my Shrink had departed this mortal coil. The receptionist laughed and assured me he was alive and well. Two weeks after that I recieved a phone call from that same receptionist. My Shrink had decided to die after all. 

I was left somewhat paranoid and without a psychiatrist.